A male patient in his 70s experienced peritoneal dissemination recurrence after resection for hepatocellular carcinoma. The disease progressed despite initial atezolizumab+bevacizumab combination therapy. Consequently, durvalumab+tremelimumab combination therapy was initiated. After one treatment course, the peritoneal disseminated lesions reduced in size, and the protein induced by vitamin K absence or antagonist-II (PIVKA-II) values remarkably decreased. After seven chemotherapy courses, the peritoneal disseminated lesions disappeared, and the PIVKA-II values decreased to normal levels. Peritoneal recurrence after liver resection is generally considered to have a poor prognosis. This case report describes the remarkable efficacy of a combination therapy with durvalumab+tremelimumab after atezolizumab+bevacizumab in advanced hepatocellular carcinoma.
A 70-year-old female patient was diagnosed with autoimmune hepatitis (AIH) at the age of 58 years based on antinuclear antibodies (1:1280) and liver biopsy findings. She received prednisolone (PSL). Over time, elevated levels of liver enzymes and alkaline phosphatase were observed, and 12 years later, a repeat liver biopsy revealed no signs of AIH but showed characteristics of primary biliary cholangitis (PBC). After reducing the PSL dose and starting ursodeoxycholic acid and pemafibrate, the blood test results improved. A liver biopsy is useful if a change in the condition is suspected, even in a patient undergoing follow-up for AIH or PBC.
The patient was an 82-year-old woman who underwent endoscopic submucosal dissection for a 10mm neuroendocrine tumor (NET) in her rectum at 72 years of age. For the first 7 years, she remained free of recurrence;however, at a follow-up examination 9 years after the procedure, multiple liver tumors were detected. No recurrence was noted in the rectum. A liver biopsy revealed a dense proliferation of small cells, consistent with the findings of the original NET, leading to a diagnosis of recurrence. Currently, she is receiving treatment with lutetium-labeled octreotide. Although the guidelines regarding the optimal follow-up duration after treatment for rectal NET remain unclear, long-term surveillance is considered necessary.
A 77-year-old man with unresectable advanced gastric cancer, complicated by multiple liver and distant lymph node metastases, began drug therapy. As a third-line treatment, nivolumab was administered for two courses;however, the patient developed destructive thyroiditis. Treatment with nivolumab was resumed after clinical improvement, but the patient developed interstitial pneumonia following a total of four courses, leading to discontinuation of treatment. Although nivolumab was discontinued and no further drug therapy was initiated, tumor shrinkage persisted for 15 months. Notably, the metastatic lesions remained stable and the tumor markers had not increased even 29 months later. The patient's clinical course differed from that typically observed in patients treated with conventional cytotoxic agents, as tumor shrinkage continued long after the discontinuation of nivolumab.
